[弥漫性大B细胞淋巴瘤R-CHOP方案治疗的预后因素分析]

[Prognostic factors analysis for R-CHOP regimen therapy in diffuse large B cell lymphoma].

作者信息

Shen Yang, Yao Yu, Li Jun-Min, Chen Qiu-Sheng, You Jian-Hua, Zhao Hui-Jin, Chen Shu, Shen Zhi-Xiang

机构信息

Department of Hematology, Ruijin Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai 200025, China.

出版信息

Zhonghua Xue Ye Xue Za Zhi. 2008 Apr;29(4):252-7.

PMID:18843980

Abstract

OBJECTIVE

To reassess the prognostic factors of diffuse large B cell lymphoma (DLBCL) treated with R-CHOP therapy.

METHODS

One hundred and twenty five patients were enrolled in this study from Feb. 2000 to Sep. 2006. They received 6 courses of R-CHOP regimen consisting of rituximab 375 mg/ m2, intravenously, d 1; cyclophosphamide 750 mg/m2, bolus intravenously, d 2; doxorubicin 50 mg/m2, bolus intravenously, d 2; vincristine 1.4 mg/m2, bolus intravenously, d 2 and prednisone 60 mg, orally, d 2 - 6. All the patients were evaluated and followed up after the treatment.

RESULTS

Eighty six patients (68.8%) achieved complete response (CR), 16 (12.8%) partial response (PR), 11 (12.8%) stable disease (SD) and 12 (9.6%) progressive disease (PD). In univariate analysis, performance status (PS), clinical stage, LDH level, extranodal disease, international prognostic index (IPI) and bulky disease were statistically significantly correlated with the induction of CR; however, only PS, clinical stage and bulky disease remained significant in multi-variate analysis (P = 0.0098, 0.000 and 0.004, respectively). Twenty four month for time to treatment failure (TTF) rate, overall survival (OS) rate, and disease free survival (DFS) rate was (59.7 +/- 5. 3)%, (67.1 +/- 5.6)% and (77.6 +/- 5.8)%, respectively. In univariate analysis, LDH, clinical stage and PS exerted significant effect on TTF and OS rate, but not on DFS rate; age and extranodal disease was not related with TTF, OS and DFS rate. In multi-variate analysis, achieved CR was the only prognostic factor for TTF (P =0.001) and bulky disease had influence on DFS rate. LDH level, PS, and achieved CR was correlated with the OS rate in multi-variate setting (P = 0.002, 0.009 and 0.001 respectively).

CONCLUSION

IPI score has its limitation in predicting the prognosis in the R-CHOP era in DLBCL. Other two relevant prognostic factors are bulky disease and achieved CR after 6 courses of treatment.

摘要

目的

重新评估接受R-CHOP方案治疗的弥漫性大B细胞淋巴瘤（DLBCL）的预后因素。

方法

2000年2月至2006年9月，125例患者纳入本研究。他们接受6个疗程的R-CHOP方案，包括利妥昔单抗375mg/m²，静脉滴注，第1天；环磷酰胺750mg/m²，静脉推注，第2天；多柔比星50mg/m²，静脉推注，第2天；长春新碱1.4mg/m²，静脉推注，第2天；泼尼松60mg，口服，第2 - 6天。所有患者治疗后均进行评估和随访。

结果

86例患者（68.8%）达到完全缓解（CR），16例（12.8%）部分缓解（PR），11例（12.8%）病情稳定（SD），12例（9.6%）疾病进展（PD）。单因素分析中，体能状态（PS）、临床分期、乳酸脱氢酶（LDH）水平、结外病变、国际预后指数（IPI）和大包块病变与CR诱导在统计学上显著相关；然而，多因素分析中只有PS、临床分期和大包块病变仍具有显著性（P分别为0.0098、0.000和0.004）。治疗失败时间（TTF）率、总生存（OS）率和无病生存（DFS）率的24个月分别为（59.7±5.3）%、（67.1±5.6）%和（77.6±5.8）%。单因素分析中，LDH、临床分期和PS对TTF和OS率有显著影响，但对DFS率无影响；年龄和结外病变与TTF、OS和DFS率无关。多因素分析中，达到CR是TTF的唯一预后因素（P =0.001），大包块病变对DFS率有影响。多因素分析中，LDH水平、PS和达到CR与OS率相关（P分别为0.002、0.009和0.001）。